Calcium as an Inopressor
- calcium has inotropic and vasopressor effects
- A direct relationship between ionized calcium levels in the blood and arterial pressure has been found in the critically ill
- Positive inotropy without increase in HR
- increases MAP and LV stroke work index
- Reversal of myocardial depression caused by halogenated anaesthetics, hypocalcemia, calcium blocking drugs, post cardiopulmonary bypass, B blockers
- Reversal of cardiac toxicity of hyperkalemia
- In the setting of ischemia calcium administration may cause increased intracellular calcium accumulation and accelerate cell death
- Potential for ‘stone heart’ in patients on digoxin (extremely unlikely to be clinically significant)
- incompatibilities with other agents
- extravasation and tissue necrosis
- overshoot may result in symptomatic hypercalcaemia
- no high level evidence with patient-orientated outcomes
- based on laboratory studies, animal models and proof-of-concept studies in humans
References and Links
- CCC – Calcium metabolism
- CCC – Calcium basics
- CCC – Hypercalcaemia Overview
- CCC – Hypercalcaemia DDx
- CCC – Hypocalcaemia
- CCC – Hypocalcaemia DDx
- CCC – Calcium replacement (advantages/disadvantages)
- CCC – Calcium as an inopressor
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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